For a little more than a year, Southeast Michigan has been hit with a frightening number of hepatitis A cases, proving to be one of the largest such outbreaks to ever occur in this country. More than 500 cases have been reported so far this year, which is more than 10 times the normal rate of infection.Naturally, the biggest questions on most peoples’ minds are, what the heck is hepatitis A, what can be done about it, and how can I keep from getting it? And what happens to me if I do get it?To get some answers, I spoke with Dr. Nasir Husain from the Henry Ford Macomb Hospital.What is hepatitis A?Hepatitis A is the name of a virus that infects the liver. After getting infected, in about three to six weeks, you develop symptoms, related mainly to fever, tiredness, fatigue. You might have pain in the liver, which is on the right side below the chest. Sometimes you become nauseous. But a lot of these patients who do develop Hepatitis A, they can have extremely mild symptoms and not even realize they have hepatitis. However, two weeks before these patients develop symptoms, they’re extremely infectious. And the virus is passed through the stool, and we do see in the community if people who are infected and they haven’t yet developed symptoms, for two weeks before they develop symptoms, if they don’t wash their hands after using the bathroom, their hands have the virus and they can contaminate door handles, food, faucets and so on. And if another person who’s not immune to this infection — you can get immunity by getting vaccinated — when they touch these surfaces, and they happen to be having a meal, or maybe they just touch their lips, they can then get infected. It’s extremely infectious.And that’s the problem be-cause when people are sick, they tend to stay away from public gatherings, but here they feel perfectly fine — except they’re infectious. And so that’s part of the reason why this infection spreads very rapidly in the community (because people who are unknowingly infected are interacting with others and spreading the disease).Why is the disease targeting this area?If a virus has taken hold in a certain community, and that community does not have immunity against the infection, the virus tends to find people who it can infect. And so it keeps circulating in the community and spreading in the community. Say for instance you go to a small town, and some food handler has this infection, and he contaminates the food material, people will go there, eat food, get infected, then pass it on to someone else and on and on and on.So, to break this cycle in a community, either people get infected and become immune and they stop passing the virus, or they get vaccinated, and then the virus enters the body and it cannot set up an infection.So how do we contain the virus at this point?At this point, there is an extensive campaign by the health department, and they’ve requested hospitals, doctors and obviously the public in general to get vaccinated. We’re trying to encourage everyone in the community to (do this). Folks who don’t have insurance can go to the health department to get vaccinated. The health department has put out posters, information booklets. They’re trying to encourage the public in general, and obviously the health care providers, to offer this vaccine to people who may be at risk. If you don’t get vaccinated, how bad can it get for someone who contracts the virus? Can it become fatal?Think of the disease as a spectrum; a person can get infected and it may be a mild dis-ease for him, and he just may feel tiredness, malaise, have poor appetite, and just get sick for a month or so. Never get jaundiced, a yellowness of the eyes. Jaundice is a sign that your liver has been extensively damaged. So you can get minimal infection where you’re sick for a month or so, to where you can die from this infection. I’ve heard about 20 deaths in Southeast Michigan so far from this infection, which is very significant, especially if it’s a vaccine preventable disease.Was there an origin case here in Southeast Michigan?This particular epidemic — we call it an epidemic because every year we have 30, 40, 50 cases, and this year we’ve had almost 500 — how it started was interesting because most of the time when we hear about hepatitis A, it is an infection that people get from contaminated produce. It is called a controlled source epidemic (which makes it easier to track origins and control). This year’s epidemic, what happened is there was no common food source. This started in (a particular group of people), namely people who are incarcerated, the commercial sex workers, people who have male-male sex, people who are homeless, and the health care workers, meaning physicians, emergency room workers, ambulance workers (who had to treat the infected). And because it got into the community in these different groups, it continued to spread to other areas of the society. And so if some-one in this high risk group was also a food handler, you can see how this thing just perpetuates itself. So to sum up?The two or three things we encourage people to do are to make sure they wash their hands so they don’t inadvertently become transmitters, to encourage everyone to get the vaccine; the vaccine is extremely potent and effective, and it’s a two-part vaccine; they get two vaccines six months apart. And if they get both vaccines it is 100 percent effective and is life-long immunity. It’s a great vaccine, preventing a disease that could be lethal. Encouraging everyone to get the vaccine is the best way to stop the disease in its tracks.
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